Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study

Abstract

Objective To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST. Design A retrospective multicentre cohort study. Settings Four French ENT paediatric departments. Participants A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the “OLST Fusobacterium group” and 24 in the “OLST other bacteria group”. Results There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow‐up, the clinical course was good in both groups without any neurological sequelae. Conclusions Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.

Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review

“…For how long the antibiotic treatment should be continued is still uncertain. In consideration of the more aggressive clinical presentation, a one-month antibiotic course has been suggested for Fusobacterium infections [28].…”

“…Moreover, the authors proposed that all patients with an otogenic CVST diagnosis should be screened for thrombophilia in order to evaluate the risk of thrombosis recurrence and treatment duration [9,32]. Nonetheless, thrombophilia screening remains a matter of debate as it is expensive and no evidence of robust proof of its relevance exists [28].…”

“…A significant association with otogenic CVST ( P < .001) was first observed in a recent retrospective study by Coudert et al When compared to the CVST from other bacteria groups, the same study showed that children in the CVST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation, with a higher CRP and larger subperiosteal abscess’. These patients generally required a combination of medical and surgical treatment and a longer hospital stay [ 28 ].…”

Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review.

“…A signi cant association with otogenic CVST (P < .001) was rst observed in a recent retrospective study by Coudert et al When compared to the CVST from other bacteria groups, the same study showed that children in the CVST Fusobacterium group were signi cantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation, with a higher CRP and larger subperiosteal abscess'. These patients generally required a combination of medical and surgical treatment and a longer hospital stay [28].…”

“…Nonetheless, thrombophilia screening remains a matter of debate as it is expensive and no evidence of robust proof of its relevance exists [28].…”